In the Journals Plus

Chemoradiation improves survival for elderly patients with non-small cell lung cancer

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February 12, 2018

Treatment with chemoradiation prolonged OS compared with radiation alone among elderly patients with stage III non-small cell lung cancer, according to a study published in Journal of Thoracic Oncology.

“Nearly 70% of all lung cancer diagnoses and more than 70% of lung cancer deaths in the U.S. occur [among] patients [aged 65 years or older]. However, the elderly are underrepresented in clinical trials, making treatment decisions in this population challenging,” Eric D. Miller, MD, PhD, of the department of radiation oncology at The Ohio State University, and colleagues wrote. “Overall, the available data guiding decision-making [among] the elderly is limited.”

Researchers used the National Cancer Data Base to identify patients aged older than 70 years with stage III NSCLC not treated surgically from 2003 to 2014.

Patients received definitive radiation (n = 5,023) or definitive chemoradiation (n = 18,206). Researchers further categorized patients receiving chemoradiation as concurrent (radiation and chemotherapy started within 30 days of each other, n = 15,840) or sequential (radiation started more than 30 days after chemotherapy, n = 2,366).

Median follow-up was 15.5 months.

Researchers found patients who were younger, male and white; who had higher income, a Charlson/Deyo score less than 1 or stage IIIB disease; and who lived in a nonmetropolitan county or further from the treating hospital appeared more likely to receive chemoradiation.

Median OS was 17.2 months among patients receiving chemoradiation compared with 12.2 months among those who received radiation alone.

After propensity score matching, elderly patients who received chemoradiation had improved OS (HR = 0.67; 95% CI, 0.64-0.7) compared with patients who received radiation alone.

Results also showed a 9% reduction in risk for death among patients receiving sequential chemoradiation (HR = 0.91; 95% CI, 0.85-0.96) compared with concurrent chemoradiation.

Among elderly patients who received chemoradiation, those who received multiagent chemotherapy (n = 15,715) demonstrated greater survival benefits (HR = 0.64; 95% CI, 0.61-0.67) than those who received single-agent chemotherapy (HR = 0.83; 95% CI, 0.75-0.92).

Study limitations included incomplete data from the National Cancer Data Base on treatment, toxicity, quality of life and cause of death.

“Treatment of the elderly with stage III NSCLC should involve a multidisciplinary discussion,” the researchers wrote. “All patients not eligible for surgery should first be considered for [chemoradiation], with either concurrent or sequential radiation. Based on our findings, multiagent chemotherapy is preferred over single-agent regimens in suitable patients.” – by Cassie Homer

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Disclosures: The authors report no relevant financial disclosures.